When Children Grow Up

In my last editorial, I discussed the challenges and potential obstacles faced by adolescents and young adults with diabetes. I would like to take this opportunity to focus on a frequent impediment to the provision of ideal care for this age group: the transition from pediatric to adult diabetes care providers.

All too often, adolescents "graduate" to adult diabetologists without sufficient planning. Identification of this issue and the development of strategies to address our shortcomings have recently been a focus of our program at Riley Hospital for Children and the Indiana University School of Medicine. It's a topic that has also gained the attention of the American Diabetes Association and other patient advocacy groups.

As pediatric endocrinologists and in pediatric diabetes care teams, we routinely rely on our patients' parents and other caregivers to assist children with their daily diabetes management. An abrupt change to the adult care model can leave an unprepared young adult with full responsibility for the multitude of tasks demanded by this chronic disease: self-monitoring of blood glucose, recording and trend analysis, carbohydrate intake assessment, insulin administration, maintenance of supply inventory, pharmacy ordering, and provision of adequate health insurance.

In contrast, the ideal diabetes center would provide comprehensive, multidisciplinary diabetes care throughout early childhood and adolescence, and into adulthood in a seamless fashion. In this way, the transitioning young adult would have the opportunity to establish a familiarity and relationship with adult care providers before the actual handoff of care. This is particularly important for people with type 1 diabetes, because of the intensive nature of their disease management.

Of course, this ideal scenario assumes that appropriate facilities exist for such a center and that the patient will continue to receive diabetes care in the same locale. The former is not the case in most communities, and the latter is frequently untrue as patients attend college or seek employment outside of commuting distance. While acknowledging that the ideal does not apply to many patients, we must improve the coordination and continuity of care.

In our program, we have surveyed providers of adult diabetes care throughout Indiana to determine their interest in working with young adults. We communicate with those providers when making a referral and encourage our patients and their families to "interview" prospective care providers before making their selection. In addition, with each referral we request feedback from our former patients regarding their experiences so that we may identify attractive adult practices throughout our referral area.

It is my belief that, as diabetes care professionals, we must work to improve communication among pediatric and adult care providers and to develop a true nationwide network that better meets the needs of our patients.